Many craniofacial and neurosurgical procedures rely on cranial bone as a bone graft. In the majority of instances, the bone heals and gives good results. But we found that if either the dura or the pericranium were missing adjacent to the cranial bone, bone absorption would be increased. We studied a single animal model, investigating the contribution of the dura and the pericranium in the process of cranial bone absorption. The animals were divided into four groups of each five animals depending on the differential blockade of the dura and/or the pericranium by silastic sheet. Bilateral $100-mm^2$, parietal bone flaps were harvested from mature rabbits. Animals were humanely killed after 12 weeks, and histomorphometric analysis was performed. The volume maintenance is as follows; Group I; 89.0%, Group II; 80.0%, Group III; 63.3%, Group IV; 52.4%. The weight maintenance; Group I; 87.1%, Group II; 79.4%, Group III; 61.6%, Group IV; 51.1%. The histological contribution of living bone; Group I; 92.9%, Group II; 85.6%, Group III; 71.1%, Group IV; 56.2%. Significantly increased bone absorption occurred in Group II, III, IV compared with Group I. Conclusions are: 1. Cranial bone absorption is effected by both the dura and the pericranium. 2. The dura is more important than the pericranium in preventing cranial bone absorption. 3. The dura to be the source of central cranial bone and the pericranium to be the source of peripheral cranial bone.
Biochemical markers of bone turnover has received increasing attention over the past few years, because of the need for sensitive and specific tool in the clinical investigation of osteoporosis. Bone markers should be unique to bone, reflect changes of bone loss, and should be correlated with radiocalcium kinetics, histomorphometry, or changes in bone mass. The markers also should be useful in monitoring treatment efficacy. Although no bone marker has been established to meet all these criteria, currently osteocalcin and pyridinium crosslinks are the most efficient markers to assess the level of bone turnover in the menopausal and senile osteoporosis. Recently, N-terminal telopeptide (NTX), C-terminal telopeptide (CTX) and bone specific alkaline phosphatase are considered as new valid markers of bone turnover. Recent data suggest that CTX and free deoxypyridinoline could predict the subsequent risk of hiP fracture of elderly women. Treatment of postmenopausal women with estrogen, calcitonin and bisphosphonates demonstrated rapid decrease of the levels of bone markers that correlated with the long-term increase of bone mass. Factors such as circadian rhythms, diet, age, sex, bone mass and renal function affect the results of biochemical markers and should be appropriately adjusted whenever possible. Each biochemical markers of bone turnover may have its own specific advantages and limitations. Recent advances in research will provide more sensitive and specific assays.
Alveolar bone resorption are unpredictable and always occur after tooth extraction. Such bone resorption causes insufficient alveolar ridge which make implant placement difficult. There are many techniques to increase the alveolar ridge. Representative procedures include ridge split, guided bone regeneration, bone graft using autogenous block bone, and alveolar distraction. In each procedure, there are indications and complications. Depending on the shape and the width of bone defects, we can choose procedures for horizontal bone augmentation and vertical bone augmentation.
Purpose: The purpose of this study was to compare the bone regeneration effects of cortical, cancellous, and cortico-cancellous human bone substitutes on calvarial defects of rabbits. Methods: Four 8-mm diameter calvarial defects were created in each of nine New Zealand white rabbits. Freeze-dried cortical bone, freeze-dried cortico-cancellous bone, and demineralized bone matrix with freeze-dried cancellous bone were inserted into the defects, while the non-grafted defect was regarded as the control. After 4, 8, and 12 weeks of healing, the experimental animals were euthanized for specimen preparation. Micro-computed tomography (micro-CT) was performed to calculate the percent bone volume. After histological evaluation, histomorphometric analysis was performed to quantify new bone formation. Results: In micro-CT evaluation, freeze-dried cortico-cancellous human bone showed the highest percent bone volume value among the experimental groups at week 4. At week 8 and week 12, freeze-dried cortical human bone showed the highest percent bone volume value among the experimental groups. In histologic evaluation, at week 4, freeze-dried cortico-cancellous human bone showed more prominent osteoid tissue than any other group. New bone formation was increased in all of the experimental groups at week 8 and 12. Histomorphometric data showed that freeze-dried cortico-cancellous human bone showed a significantly higher new bone formation percentile value than any other experimental group at week 4. At week 8, freeze-dried cortical human bone showed the highest value, of which a significant difference existed between freeze-dried cortical human bone and demineralized bone matrix with freeze-dried cancellous human bone. At week 12, there were no significant differences among the experimental groups. Conclusions: Freeze-dried cortico-cancellous human bone showed swift new bone formation at the 4-week healing phase, whereas there was less difference in new bone formation among the experimental groups in the following healing phases.
This study was designed to evaluate the bone formation capability of the bone substitute when compared with autogenic bone, freeze-dried demineralized allogeneic bone and bioglass into parietal bone of the rats. We made the parietal bone defects in $7{\times}7mm$ size on rats and has performed the bone graft in each experimental groups. Postoperatively 1, 2, 4, 6, 8, weeks, each specimen stained with H & E, Masson's trichrome methods. We evaluated the osteogensis capability in each groups. The result were as follow : 1. Inflammatory cell infiltration approached at 1 week and disappeared at 4 weeks in all experimental group, expecially severe in freeze-dried demineralized allogeneic bone group. 2. New capillry proliferation was increased in autogeneic bone graft group than any other groups and was increased till 2 weeks and decreased in freeze-dried demineralized allogeneic bone group and was few in bioglass group. 3. Osteoblastic activity increased in autogeneic bone and freeze-dried demineralized allogeneic bone groups till 4 weeks, and decreased in 6 weeks which no difference between these groups. But, few occurred in bioglass group till 6 weeks. 4. Initial osteoclastic activity was prominent in freeze-dried demineralized allogeneic bone group and few in autogeneic bone group. 5. New bone formation bega at 1 week in autograft and freeze-dried demineralized allogenic bone groups, but, mild new bone formation at 8 weeks in bioglass.
PURPOSE. The purpose of this prospective study was to evaluate the effectiveness of newly developed autogenous tooth bone graft material (AutoBT)application for sinus bone graft procedure. MATERIALS AND METHODS. The patients with less than 5.0 mm of residual bone height in maxillary posterior area were enrolled. For the sinus bone graft procedure, Bio-Oss was grafted in control group and AutoBT powder was grafted in experimental group. Clinical and radiographic examination were done for the comparison of grafted materials in sinus cavity between groups. At 4 months after sinus bone graft procedure, biopsy specimens were analyzed by microcomputed tomography and histomorphometric examination for the evaluation of healing state of bone graft site. RESULTS. In CT evaluation, there was no difference in bone density, bone height and sinus membrane thickness between groups. In microCT analysis, there was no difference in total bone volume, new bone volume, bone mineral density of new bone between groups. There was significant difference trabecular thickness ($0.07{\mu}m$ in Bio-Oss group Vs. $0.08{\mu}m$ in AutoBT group) (P=.006). In histomorphometric analysis, there was no difference in new bone formation, residual graft material, bone marrow space between groups. There was significant difference osteoid thickness ($8.35{\mu}m$ in Bio-Oss group Vs. $13.12{\mu}m$ in AutoBT group) (P=.025). CONCLUSION. AutoBT could be considered a viable alternative to the autogenous bone or other bone graft materials in sinus bone graft procedure.
Journal of the Korean Association of Oral and Maxillofacial Surgeons
/
제30권4호
/
pp.331-338
/
2004
Stress transfer to the surrounding tissues is one of the factors involved in the design of dental implants. Unfortunately, insufficient data are available for stress transfer within the regenerated bone surrounding dental implants. The purpose of this study was to investigate the concentration of stresses within the regenerated bone surrounding the implant using three-dimensional finite element stress analysis method. Stress magnitude and contours within the regenerated bone were calculated. The $3.75{\times}10-mm$ implant (3i, USA) was used for this study and was assumed to be 100% osseointegrated, and was placed in mandibular bone and restored with a cast gold crown. Using ANSYS software revision 6.0, a program was written to generate a model simulating a cylindrical block section of the mandible 20 mm in height and 10 mm in diameter. The present study used a fine grid model incorporating elements between 165,148 and 253,604 and nodal points between 31,616 and 48,877. This study was simulated loads of 200N at the central fossa (A), at the outside point of the central fossa with resin filling into screw hole (B), and at the buccal cusp (C), in a vertical and $30^{\circ}$ lateral loading, respectively. The results were as follows; 1. In case the regenerated bone (bone quality type IV) was surrounded by bone quality type I and II, stresses were increased from loading point A to C in vertical loading. And stresses according to the depth of regenerated bone were distributed along the implant evenly in loading point A, concentrated on the top of the cylindrical collar loading point B and C in vertical loading. And, In case the regenerated bone (bone quality type IV) was surrounded by bone quality type III, stresses were increase from loading point A to C in vertical loading. And stresses according to the depth of regenerated bone were distributed along the implant evenly in loading point A, B and C in vertical loading. 2. In case the regenerated bone (bone quality type IV) was surrounded by bone quality type I and II, stresses were decreased from loading point A to C in lateral loading. Stresses according to the depth of regenerated bone were concentrated on the top of the cylindrical collar in loading point A and B, distributed along the implant evenly in loading point C in lateral loading. And, In case the regenerated bone (bone quality type IV) was surrounded by bone quality type III, stresses were decreased from loading point A to C in lateral loading. And stresses according to the depth of regenerated bone were distributed along the implant evenly in loading point A, B and C in lateral loading. In summary, these data indicate that both bone quality surrounding the regenerated bone adjacent to implant fixture and load direction applied on the prosthesis could influence concentration of stress within the regenerated bone surrounding the cylindrical type implant fixture.
The purpose of the present study was to evaluate the effect of bone graft materials including deproteinized bovine bone(DBB), demineralized freeze-dried bone(DFDB), freeze-dried bone(FDB) on bone formation in guided bone regeneration using perforated titanium membrane(TM). 16 adult male rabbits(mean BW 2kg) were used in this study and 4 rabbits allotted to each test group. Intramarrow penetration(diameter 6.5mm) was done with round carbide bur on calvaria to promote blood supply and clot formation in the wound area. The test groups were devided into 4 groups as follows: TM only(test 1), TM +DBB(test 2), TM +DFDB(test 3), TM +FDB(test 4). Perforated titanium membrane was contoured in rectangular parallelepiped shape(0.5mm pore diameter, 10mm in one side, 2mm in inner height), filled the each graft material and placed on the decorticated carvaria. Perforated titanium membrane was fixed with resorbable suture materials. The animals were sacrificed at 2, 8 weeks after the surgery. Non-decalcified preparations were routinely processed for histologic analysis. The results of this study were as follows: 1. Perforated titanium membrane was biocompatible. 2. Perforated titanium membrane had capability of maintaining the space during the healing period but invasion of soft tissue through the perforations of titanium membrane decreased the space available for bone formation. 3. In test 1 group without bone graft material, the amount of bone formation and bone maturation was better than other test groups. 4. Among the graft materials, the effect of freeze-dried bone on bone formation was best. 5. In the test groups using deproteinized bovine bone, demineralized freeze-dried bone, bone formation was a little. The spacemaking capability of the membrane may be crucial for bone formation. The combined treatment with the perforated titanium membrane and deproteinized bovine bone or demineralized freeze-dried bone failed to demonstrate any added effect in the bone formation. Minimization of size and numbers of perforations of titanium membrane or use of occlusive titanium membrane might be effective to acquire predictable results in the vertical bone formation.
Bone graft has been used to repair one defect caused by disease and trauma, congenital and acquired deformities. Graft materials are autogenous bone, allogenic bone, xenogenic bone, synthetics. Autogenous bone graft is the most superior to other materials for immunologic reaction, compatibility to host tissue, and revascularization. However, autogenous bone graft is required for additional operation and the amount of taking is limited. Autografts are obtained at own expense and also limited in size, shape. In order to compensate these problems, allogenic bone graft has been used increasingly. But allogenic bone graft encounters immunologic complications. Therefore, it has been used after freezing, lyophilization, or demineralization. Allogenic bone processed by only lyophilization includes potential antigenic properties on its surface, therefore it is demineralized to deplete immunologic reaction. Demineralized bone releases BMP and helps the mesenchymal cells transform to the chondroblast to produce cartilage and bone. This reaction is called osteoinducation. Many authors have reported that mineralized lyophilized bone had less antigenicity clinically and favorable bony consideration with host bone. In our department from 1995 to now, we have used banked allogenic bone graft that has been prepared from Wonkwang Bone Bank in 5 cases and mineralized lyophilized bone graft in 2 cases to reconstruct the maxillofacial bone defect after tumor resection and cyst enucleation and cleft alveolus. We will report with literature review that the result is favorable functionally and esthetically.
Allogeneic bone grafting has recently been used in oral and maxillofacial regions to restore the cosmetic and functional problem. There are several types of allogeneic bone grafts ; bone powder, bone chips, bone blocks. Empirically, it is thought to be better to combine the allogeneic bone chips to any type of tissue adhesive not to displace during packing and condensing. But, there are no reports about using tissue adhesive in allogeneic bone grafting. This experimental study is designed to investigate the effect of the fibrin adhesive on bone healing process after demineralized allogeneic bone grafting in 60 rats. In control groups (30 rats), routine demineralized allogeneic bone grafting were done in 7 ${\times}$ 7mm calvarial bone defects which were drilled intentioally. And we used the fibrin adhesive for holding the bone particle in experimental groups (30 rats). Each experimental specimen was sacrified at 1, 2, 4, 6, 8 weeks postoperatively The results were as follows : 1. The degree of inflammatory cell infiltrations were more prominent in experimental than in control groups till 2 weeks. 2. Early fibroblast proliferation and new capillary proliferation were uncorporated around graft sites in the experimental groups later than in control groups at early stages. 3. Osteoblastic activity in control group was more prominent at 2 weeks. 4. Osteoblastic activity in experimental groups was more prominent than in control group till 4 weeks. 5. New bone formation was more in control group than experimental group till 3 weeks, but similar appearance after that time. As above results, initial bone healing within 2 weeks were more processed in without adhesive group than with adhesive group. But above 4 weeks; similar bone healing were observed.
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